tbuckley/cabot-search huggingface dataset:
Abstract 30: Associations of Accelerometer-Measured Machine-Learning Classified Sitting With All-Cause and Cardiovascular Disease Mortality Among Older Women: The Opach Study
Authors: Steve Nguyen, John Bellettiere, Chongzhi Di, Blake Anuskiewicz, Loki Natarajan, Michael J Lamonte, Andrea Z LaCroix
Journal: Circulation (2023)

Introduction: Sedentary behavior (SB) is a recognized mortality and CVD risk factor. Most studies with accelerometry classified SB using cut-points, which do not capture postural transitions as accurately as thigh-worn devices. The recently published convolutional neural network hip accelerometer posture (CHAP) algorithm more accurately classifies sitting than cut-point methods. Hypothesis: Higher amounts of CHAP-classified sitting time (ST) and mean sitting bout duration (MSBD) are associated with higher all-cause (ACM) and CVD mortality risk. Methods: Older women (n=6,056; mean age=79±7; 34% Black, 17% Hispanic) in the Objective Physical Activity and Cardiovascular Health (OPACH) study without prior MI or stroke wore accelerometers for 7 days in May 2012-April 2014 and were followed through February 19, 2022 for mortality. The CHAP algorithm has been shown to have higher sensitivity (97.1% vs 88.2%) and specificity (88.6% vs 59.7%) for classifying sitting compared to the 100 counts/minute cut-point. Cox models estimated hazard ratios (HR) and 95% confidence intervals (CI) for ACM and CVD mortality adjusting for age, race/ethnicity, education, alcohol, smoking, multimorbidity, self-rated health, physical functioning, HDL, triglycerides, SBP, and log hs-CRP. Results: There were 1,808 deaths and 651 CVD deaths over a median follow-up of 8.4 years. The HR (95% CI; P-trend) comparing women in the highest ST quartile (&gt;11.6 hr/day) to those in the lowest (&lt;9.2 hr/day) was 1.43 (1.23-1.66; &lt;0.001) for ACM and 1.64 (1.27-2.14; &lt;0.001) for CVD mortality. The HR (95% CI; P-trend) comparing women in the highest MSBD quartile (&gt;15 minutes) to those in the lowest (&lt;9.3 minutes) was 1.33 (1.15-1.55; &lt;0.001) for ACM and 1.50 (1.16-1.94; &lt;0.001) for CVD mortality. The HR (95% CI) for women with the highest ST and MSBD was 1.63 (1.38-1.93) for ACM and 1.95 (1.47-2.60) for CVD mortality. Conclusions: ST and MSBD were positively associated with ACM and CVD mortality risk, supporting interventions aimed at reducing both ST and MSBD.
Abstract P571: Investigating Factors Relevant to Understanding the Hispanic Health Paradox in Patients After Cardiac Arrest
Authors: Marthina A Correa, Gaspar J Cruz, Michelle L David, Danielle A Rojas, Isabella M Tincher, Gabriel J Sanchez, Tara St. Onge, Jeffrey L Birk, Sachin Agarwal
Journal: Circulation (2023)

Introduction: The growing Hispanic community faces disproportionate hardship due to lower financial capital and educational opportunity. The Hispanic health paradox refers to the finding that Hispanics tend to have better cardiovascular outcomes than non-Hispanics, despite facing greater hardships and more cardiovascular risk factors. Behavioral (e.g., sleep) and psychological (e.g., optimism) factors predict recovery after acute coronary syndrome events, but less is known about how these factors differ by ethnicity after cardiac arrest (CA). We tested demographic, psychological, behavioral, and recovery factors that may underlie the Hispanic health paradox among CA survivors. Hypothesis: We hypothesized that Hispanic vs. non-Hispanic cardiac arrest survivors would have lower income and education but would not differ in behavioral, psychological, and recovery factors. Methods: An observational cohort study, Psychological predictors of recovery after an Acute Cardiac Event (PACE) , enrolled 68 neurologically intact CA survivors admitted to NewYork-Presbyterian Hospital. At hospital discharge, self-reported demographic, psychological, behavioral, and recovery variables were assessed. Independent-samples t-tests of Hispanic vs. non-Hispanic CA survivors were conducted comparing income, education, posttraumatic stress symptoms, depression, negative affect, cardiac anxiety, optimism, positive affect, social support, sleep, physical activity, independent activities of daily living, and self-maintenance. Results: As hypothesized, Hispanic vs. non-Hispanic participants had lower income, Mann Whitney U = 99.00, z = -3.46, p &lt; .01, and lower education, Mann Whitney U = 336.00, z = -2.65, p = .01. Unexpectedly, Hispanic patients reported greater cardiac anxiety M = 39.60, SD = 16.70) than non-Hispanic patients ( M = 30.29, SD = 11.67), t (66) = -2.722, p = .008. No other tested factors were significant, all p s ≥ .419. Conclusions: Cardiac anxiety is the only tested variable that differed by ethnicity. While Hispanic ethnicity may be protective for certain aspects of cardiovascular health, the present findings indicate that Hispanic CA survivors experience higher psychological distress, which itself is a known risk factor for poor health behaviors. Future research should assess potential drivers of cardiac anxiety (e.g., mistrust of healthcare system, poor patient-physician communication). Future intervention research should target heart-related fear during CA recovery.
Abstract 12: Associations Between Long-Term Body Mass Index Variability and Adverse Cardiovascular Outcomes: Million Veteran Program Study
Authors: Zakaria Almuwaqqat, Qin Hui, Jin Zhou, Benjamin F Voight, Yuk-lam Ho, Daniel Posner, Jason Vassy, Peter Wilson, Yan Sun
Journal: Circulation (2023)

Objective: Body mass index (BMI) is a commonly used estimate of obesity that is a complex multifactorial trait resulting from genetic and lifestyle factors. Weight gain and loss could correlate with adverse biological processes. Prior studies have reported that increased BMI variability predicts future adverse cardiovascular events. However, there have been no prior studies that have investigated this association in patients without cancer or preexisting cardiovascular disease among multiple ethnicities. Using the Million Veteran Program (MVP), a mega-biobank with longitudinal health record data from a large US healthcare system, we evaluated the association between BMI variability and incident cardiovascular events in an ethnically diverse longitudinal cohort (2011-2019). Methods: We studied 92,363 adults free of cardiovascular disease and cancer at baseline. BMI was longitudinally assessed from the baseline visit. BMI variability was assessed using the standard deviation (SD) and coefficient of variation (CV) of each participant. Cardiovascular disease (CVD) risk factors including age, sex, systolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, smoking status, diabetes status and statin use were assessed as covariates. We followed patients for the composite CVD events of incident non-fatal myocardial infarction, acute ischemic stroke, and cardiovascular death. Cox proportional hazards modeling was used to examine the association between BMI variability and incident CVD events after adjustment for dichotomous and continuous measures. We also assessed if results were affected sensitive to adjustment for the BMI polygenic score. Results: The cohort (88% men) included 60,180 non-Hispanic White (NHW), 22,488 non-Hispanic Black (NHB), and 9,695 Hispanic (HIS) participants with mean age 56.8 years. Patients were followed from 2011 to 2019. We observed 4,855 composite CVD events. The CV of BMI was associated with incident composite CVD across all groups, but to a stronger degree for Hispanic participants. Among the NHW, each SD increase of CV (indicative of greater BMI variability) was associated with a 15% rise in the risk of CVD events (i.e HR 1.15, 95%CI, 1.11-1.19 after adjustment of covariates. Among the NHB and HIS, results were similar: HR, 1.16 (95%CI, 1.09 - 1.22) and HR, 1.24 (95%CI, 1.12-1.38), respectively. In sensitivity analyses, we found that BMI variability is similarly predictive of the composite outcome after adjustment for BMI polygenic score. Conclusions and Relevance: Increased BMI variability is an independent risk factor for future CVD events.
Abstract P105: Peripheral Artery Disease and Subsequent Risk of Cancer: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Shoichiro Nohara, Yejin Mok, Jeremy Van't Hof, Maya Salameh, Corinne Joshu, Elizabeth Platz, Roberta Florido, Kunihiro Matsushita
Journal: Circulation (2023)

Introduction: Cardiovascular disease (CVD) and cancer share risk factors, including smoking and obesity. Indeed, an increased cancer risk was reported among patients with CVD, such as myocardial infarction. Lower extremity peripheral artery disease (PAD) has also been explored in this context, but most previous studies included only Whites, had follow-up &lt;10 years, or did not account for key confounders like smoking. Hypothesis: PAD is independently associated with long-term cancer risk in a bi-racial cohort. Methods: We studied 13,102 ARIC participants without prevalent cancer at visit 1 (1987-89) (mean age 54 [SD 6] years, 54% women, and 26% Black) (funding: NHLBI, NCI, and NPCR). Incident cancer was ascertained by linkage to cancer registries and medical record review. We categorized PAD status at visit 1 into symptomatic PAD (intermittent claudication or a history of lower extremity revascularization), asymptomatic PAD (ankle brachial index [ABI] ≤0.9), and other ABI categories of &gt;0.9-1.0, &gt;1.0-1.1, &gt;1.1-1.2, &gt;1.2-1.3 and &gt;1.3. We ran multivariable Cox models. Results: During the median follow-up of 25 years (IQI 15-27 years), there were 4,142 incident cancer cases. 25-year cumulative cancer incidence was 48% in symptomatic PAD, 39% in asymptomatic PAD, and 31-34% in the other categories. When we adjusted for demographic factors, both symptomatic and asymptomatic PAD showed significant hazard ratios for incident cancer (1.79 [95%CI 1.33-2.43] and 1.39 [1.18-1.63], respectively, vs. ABI 1.1-1.2, Model 1 in Table ). After adjusting for additional potential confounders, including smoking and diabetes, these associations were somewhat attenuated but remained consistent (Models 2-4 in Table ). Conclusion: Both symptomatic and asymptomatic PAD were associated with an increased risk of cancer independently of smoking and diabetes. Although potential mechanisms should be explored, clinicians should be aware of this excess cancer risk among patients with PAD when considering cancer prevention and screening.
Abstract 16: Maternal Coronary Heart Disease and Mortality Within 5 Years of Delivery Among Women With Hypertensive Disorders of Pregnancy and/or Diabetes
Authors: Emily Ash, Dulaney A Wilson, Daniel T Lackland, Julio Mateus, Tanya N Turan, Kelly J Hunt, Angela M Malek
Journal: Circulation (2023)

Introduction: Pre-pregnancy hypertension (HTN), hypertensive disorders of pregnancy (HDP), and diabetes are linked to increased risk of post-pregnancy coronary heart disease (CHD) and all-cause mortality, but the cumulative impact of pre-pregnancy HTN, HDP, and diabetes has yet to be fully investigated. We aimed to examine associations between HDP and diabetes with CHD and mortality ≤5 years of delivery stratified by race/ethnicity. Methods: This retrospective cohort study included women aged 12-49 with ≥1 singleton, live birth in South Carolina (2004-2016). After exclusions, 431,839 women remained: non-Hispanic White [NHW; 58.8%], non-Hispanic Black [NHB; 31.7%], and Hispanic [9.5%]. Birth certificates defined pre-pregnancy HTN, HDP (preeclampsia, eclampsia, gestational hypertension), and diabetes (pre-pregnancy, gestational); hospitalization/ED visit data also defined pre-pregnancy HTN and HDP. Hospitalization/ED visit data and death certificates defined incident CHD and all-cause mortality. Cox proportional hazard models adjusted for covariates assessed associations by condition and race/ethnicity. Results: Incident CHD risk was increased ≤5 years of delivery for women with diabetes (HR=1.79, CI: 1.40-2.29), HDP (HR=2.91, CI: 1.98-2.65), diabetes and HDP (HR=3.95 CI:3.09-5.05), pre-pregnancy HTN and HDP (HR=3.94, CI: 3.11-5.00), and all three conditions (HR=5.78, CI: 4.41-8.06) compared to none. All-cause mortality risk was increased for HDP (HR=1.31, CI: 1.08-1.58), diabetes and HDP (HR=1.93, CI: 1.30-2.87), pre-pregnancy HTN and HDP (HR=2.20, CI: 1.54-3.15), and all three conditions (HR=2.88, CI: 1.61-5.16), but not with diabetes. The table shows overall and race/ethnic-specific event rates and model results. Discussion: Women with HDP (regardless of pre-pregnancy HTN) and/or diabetes experienced higher incident CHD and all-cause mortality risk ≤5 years of delivery. Event rates were highest for women with two or three conditions, with all event rates higher for NHB than NHW women.
Abstract P147: A Community-Based, Heart-Healthy Lifestyle-Promoting Program Using Hybrid Behavioral Strategies: Study Protocol of a Three-Group Randomized Controlled Trial
Authors: Jina Choo, Songwhi Noh, Yura Shin
Journal: Circulation (2023)

Introduction: A hybrid intervention of online and offline behavioral strategies can be more effective in promoting multiple lifestyle behaviors than online strategies alone. However, little is known about the effects of hybrid behavioral strategies on the modification of multiple heart-healthy lifestyle behaviors in cardiovascular health. The present study aims to evaluate the effects of a community-based, heart-healthy lifestyle-promoting program (i.e., HeartHELP program) using hybrid behavioral strategies on heart-healthy lifestyle outcomes for individuals at cardiovascular risk. Hypothesis: We assessed three hypotheses: 1) a mobile-app group would be more likely to increase heart-healthy behavioral outcomes than a control group 2) a hybrid group would be more likely to increase heart-healthy behavioral outcomes than the control group 3) the hybrid group would be more likely to increase heart-healthy behavioral outcomes than the mobile-app group. Methods: The present study is a three-arm, parallel group, randomized controlled trial (clinical trial No. ISRCTN83643383) with assessments carried out at baseline and after a 12-week HeartHELP program. We will recruit 75 participants, each having at least one component of metabolic syndrome, in a community-based setting. The participants will be allocated to one of the following three study arms by age- and gender-stratified block randomization: (1) a hybrid group (n = 25), (2) a mobile-app group (n = 25), or (3) a control group (n = 25). The hybrid group will receive a “HeartHELP program” with hybrid strategies: (1) mobile-app use as an online strategy and (2) motivational interviewing counselling as an offline strategy. The mobile-app group will receive the online strategy exclusively. The control group will receive a brochure that will include information on cardiovascular health. The mobile-app use involves receiving text messages, self-monitoring six heart-healthy lifestyle behaviors, and receiving feedback text messages based on behavioral outcomes obtained from self-monitoring. The motivational interviewing counselling includes customized individual and group counseling based on motivational interviewing principle. At baseline and after 12 weeks, a battery of heart-healthy behavioral outcomes will be measured. The primary outcome will comprise heart-healthy behavioral practices; the secondary outcomes will be heart-healthy knowledge, heart-healthy motivation, heart-healthy self-efficacy, and cardiometabolic biomarkers (i.e., fasting glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides). In conclusion, we expect the community-based HeartHELP program to provide significant data findings on how heart-healthy behavioral practices can be improved, along with other cardiometabolic biomarkers.
Abstract P569: Social Determinants of Health and 30-day Readmission or Emergency Department Use After Acute Myocardial Infarction
Authors: Koby Amankwah, Orysya Soroka, Laura Pinheiro, Madeline R Sterling, Ernest Amankwah, Zaid Almarzooq, Monika M Safford
Journal: Circulation (2023)

Background: A more complete understanding of associations between social determinants of health (SDOH) and 30-day readmission or emergency department (ED) use following hospitalization for acute myocardial infarction (AMI) will facilitate development of targeted interventions and root cause policies to reduce readmissions. Methods: We analyzed 753 adults ≥65 years with linked Medicare data from the REasons for Geographic and Racial Differences in Stroke study who were discharged from the hospital after an adjudicated AMI between 2003-19. We selected SDOH (race, education, income, Medicare+Medicaid, zip code with high poverty, rural residence, living in a Health Professional Shortage Area, and social support) with relative risk for readmission/ED use &gt;1. We grouped participants into 0 or 1, 2, 3, and 4+ SDOH. Poisson models examined crude and fully adjusted associations on risk for readmission/ED visit within 30 days. Results: Participant characteristics: 40% were women, mean age was 77 years, and 29% were readmitted or had an ED visit within 30 days. Compared to those without readmission/ED visit, those readmitted had more cognitive impairment (17 vs 10%) and depressive symptoms (57 vs. 46%); were more likely to be hospitalized in the year prior to AMI (42 vs 28%) and have adjudicated heart failure at index AMI (36 vs 25%); and were less likely to have a physician visit within 10 days (41 vs 32%) and 30 days (0/1 SDOH: 79%, 2: 73%, 3: 66%, 4+: 60%, p trend &lt; 0.0001) (all contrast p&lt;0.05). Participants with 4+ SDOH had higher risk of readmission (Table). Conclusion: 4+ SDOH were associated with higher risk of readmission/ED visit after AMI. Those with the greatest burden of SDOH were also least likely to follow up within 10 or 30 days. Policies such as the American College of Cardiology’s “See You in 7 Challenge” program may be even more effective at reducing readmission after MI if specifically targeted at patients with high burden of SDOH.
Abstract P387: Effects of Reduced Dietary Sodium and the Dash Diet on Glomerular Filtration Rate: Results From the Dash-Sodium Trial
Authors: M. Catalina Morales-Alvarez, Voravech Nissaisorakarn, Lawrence J Appel, Edgar R Miller, Robert H Christenson, Heather Rebuck, Sylvia E Rosas, Jeffrey H William, Stephen P Juraschek
Journal: Circulation (2023)

Background: While prior studies demonstrated that a low-sodium, DASH diet reduced blood pressure, the effects of sodium reduction, alone or in combination with the DASH diet, on kidney function are still unknown. Objective: We measured cystatin C in stored specimens of the DASH-Na trial, to determine the effects of sodium reduction and the DASH diet, alone or combined, on kidney function assessed by eGFR. Methods: DASH-Sodium was a controlled, feeding study in adults with pre- or stage 1 hypertension, who were randomly assigned to the DASH diet or a control diet. On their assigned diet, participants consumed each of three sodium levels for 4-weeks following a 2-week run-in period where all consumed a high sodium-control diet. The three sodium levels were low (50 mmol/d), medium (100 mmol/d), and high (150 mmol/d). Outcomes included eGFR by cystatin C (CKD-EPI 2021 equation) at baseline and at the end of each feeding period. Results: Cystatin C was measured in 409 of the original 412 participants, 207 were assigned the DASH diet, and 202 were assigned the control diet. The mean age was 48 years; 56% were women, and 56% were Black. The mean baseline BP was 135/86 mm Hg and BMI was 29.2 kg/m 2 . Compared with control, the DASH diet did not affect eGFR (β=-0.96 mL/min per 1.73 m 2 ; 95% CI: -2.74, 0.83) ( Figure ). In contrast, low versus high sodium intake decreased eGFR (β=-2.36 mL/min per 1.73 m 2 ; 95% CI: -3.64, -1.07). Together, compared to the high sodium-control diet, the low sodium-DASH diet decreased eGFR by 3.10 mL/min per 1.73 m 2 (95% CI: -5.46, -0.73). Conclusions: A combined low sodium-DASH diet reduced eGFR over a 4-week feeding period. Whether these effects are reno-protective long-term represent an important clinical inquiry for subsequent research.
Abstract P576: Disparities in Cardiovascular Disease Outcomes Among Cancer Survivors in the United States: A Systematic Review
Authors: Jean C Bikomeye, Iwalola Awoyinka, Jamila L Kwarteng, Andreas M Beyer, Kirsten M Beyer
Journal: Circulation (2023)

Significance: Cardiovascular diseases (CVD) and cancer are leading causes of morbidity and mortality in the US; and cancer survivors are at increased risk for CVD. The risk for adverse CVD outcomes is not equitably distributed. Disparities exist; and some groups and/or communities that have been targeted for marginalization are more affected. Objective: To document known disparities in CVD outcomes among cancer survivors in the US and identify literature gaps to inform future studies. Methods: We used the Peer Review of Electronic Search Strategies (PRESS) guidelines and searched three databases: MEDLINE, PsycINFO, and Scopus on March 15 th , 2021. With a pre-defined PICOS framework, we used rayyan for articles screening and the PRISMA 2020 reporting guidelines. The Newcastle Ottawa Scale was used to assess the risk of bias. RAW Graphs were used to create alluvial charts. This review is registered with PROSPERO, ID # CRD42021236460. Results &amp; Discussion: From 6,000 articles retrieved, 13 articles met our pre-defined inclusion criteria. All studies investigated racial and ethnic disparities. Gender, age at diagnosis, and cancer stage at diagnosis, and sensitivity C-reactive protein disparities were respectively investigated by one study. The most prevalent outcome investigated is CVD mortality, followed by CVD risk, CVD event, hypertension, and cardiotoxicity. Non-Hispanic Black survivors are at increased risk for all outcomes investigated which might suggest root causes of disparities into historical and structural racism. Conclusions &amp; Implications: (1) Policy implication: There is an urgent need for stakeholders to work to eliminate root causes of disparities and all forms of injustice, by removing all systemic barriers that limit individuals’ access to essential resources needed to maintain health. (2) Clinical implication: Clinicians should increase screening for risk factors that exacerbate poor CVD outcomes. (3) Research implication: Researchers should enhance community partnerships and broaden their focus in investigating innovative approaches to reduce disparities and advance health equity and justice. Keywords: Disparities, cancer survivors, cardiovascular disease (CVD), cardio-oncology, racism, discrimination.